A comparison of the moral reasoning of physicians and clinical medical ethicists.

BACKGROUND: Because of the increasing controversy over who should provide ethics consultations, this study investigated differences in the moral reasoning and moral orientations of physicians and clinical ethicists. METHOD: From 1987 through 1990, extensive interviews were conducted with 39 physicians and 50 clinical medical ethicists (26 philosophers and 24 theologians) who were at 32 medical centers in 14 states from all sections of the United States. The interviews were used to gather selected demographic characteristics (age, gender, and profession--physician or ethicist) for the 89 individuals as well as to determine their scores for moral reasoning and moral orientation. Polyserial correlations and multivariant analyses were then performed between the demographic characteristics and the data on moral reasoning and moral orientation. RESULTS: The physicians consistently scored lower than the clinical ethicists in their moral reasoning skills in terms of both moral stage score (p < .01) and weighted average score (p < .01). However, the physicians were found not to be significantly different (p < .05) from the clinical ethicists in their moral orientations toward justice or care in terms of recognition, predominance, or alignment. No significant relationship was found between age and moral orientation. A significant relationship was found between age and stage of moral reasoning, with the older individuals scoring higher. No significant relationship was found between gender and stage of moral reasoning. A significant relationship was found between gender and moral orientation: the women were more likely to recognize elements of care in moral dilemmas and the men more likely to recognize elements of justice. CONCLUSION: This study provides initial evidence that clinical medical ethicists, whether philosophers or theologians, may be better skilled than physicians to do ethicists consultations. To the extent that higher levels of moral reasoning correlate with superior skills in performing clinical ethics consultations, this study shows the value of bringing philosophers and theologians into the clinical setting.

The influence of philosophical versus theological education on the moral development of clinical medical ethicists.

PURPOSE: Because of the increasing involvement of clinical medical ethicists in patient care and the resultant controversy over the appropriate background, training, and certification of clinical ethicists, this study was designed to investigate whether different educational backgrounds (philosophical versus theological) affected the moral reasoning of clinical ethicists and their orientations toward justice or care. METHOD: From 1987 through 1990, extensive oral interviews were conducted with 50 clinical medical ethicists (26 philosophers and 24 theologians) who were at 32 medical centers in 14 states from all sections of the United States. The interviews were used to gather selected demographic characteristics about the ethicists (age, gender, and educational background) as well as to determine the ethicists' scores for stages of moral reasoning and for moral orientation. Polyserial correlations and multivariant analyses were then performed between the demographic characteristics and the data on moral reasoning and moral orientation. RESULTS: The philosophers and theologians were found not to be significantly different (p > .05) in their moral reasoning skills in terms of either moral stage score or weighted average score. Similarly, the philosophers and theologians were found not to be significantly different in their moral orientations toward justice or care in terms of recognition, predominance, or alignment. No significant relationship was found between age or gender and moral reasoning or moral orientation. CONCLUSION: Based on the results of this study, it appears that clinical medical ethicists, whether philosophers or theologians, are a fairly homogeneous group with regard to their moral development, in terms of both their stages of moral reasoning and their moral orientations toward justice and care.

A study of the foundations of ethical decision making of clinical medical ethicists.

A study of clinical medical ethicists was conducted to determine the various philosophical positions they hold with respect to ethical decision making in medicine and their various positions' relationship to the subjective-objective controversy in value theory. The study consisted of analyzing and interpreting data gathered from questionnaires from 52 clinical medical ethicists at 28 major health care centers in the United States. The study revealed that most clinical medical ethicists tend to be objectivists in value theory, i.e., believe that value judgments are knowledge claims capable of being true or false and therefore expressions of moral requirements and normative imperatives emanating from an external value structure or moral order in the world. In addition, the study revealed that most clinical medical ethicists are consistent in the philosophical foundations of their ethical decision making, i.e., in decision making regarding values they tend not to hold beliefs which are incompatible with other beliefs they hold about values.

An analysis of ethics consultation in the clinical setting.

Only recently have ethicists been invited into the clinical setting to offer recommendations about patient care decisions. This paper discusses this new role for ethicists from the perspective of content and process issues. Among content issues are the usual ethical dilemmas such as the aggressiveness of treatment, questions about consent, and alternative treatment options. Among process issues are those that relate to communication with the patient. The formal ethics consult is discussed, the steps taken in such a consult, and whether there should be a fee charged. We conclude with an examination of the risks and benefits of formal ethics consults.

Professional liability (malpractice) coverage of humanist scholars functioning as clinical medical ethicists.

In contrast to theoretical discussions about potential professional liability of clinical ethicists, this report gives the results of empirical data gathered in a national survey of clinical medical ethicists. The report assesses the types of activities of clinical ethicists, the extent and types of their professional liability coverage, and the influence that concerns about legal liability has on how they function as clinical ethicists. In addition demographic data on age, sex, educational background, etc. are reported. The results show that while nearly one third (28.9%) of the ethicists regularly make recommendations about patient care, only 10.8% of them regularly make entries in the medical record; only approximately half (53.0%) of them are covered by professional liability (malpractice) insurance; and the vast majority (84.3%) of them say that concerns about legal liability do not influence the way the function as clinical ethicists.